title: Imiquimod therapy for extramammary Paget's disease of the vulva: a viable non-surgical alternative.
abstract: Extramammary Paget's disease (EMPD) is a rare intraepidermal adenocarcinoma that can affect the vulval skin. Surgical excision is the gold-standard treatment, however, recurrence rates are high and extensive excisions can produce long-lasting cosmetic and functional defects. We describe one of the largest case series to-date (n = 6) on the use of topical 5% imiquimod cream as a novel treatment option and discuss our experiences. With the addition of our six cases to the literature, there are now 29 documented cases of vulval EMPD treated with 5% imiquimod cream. Of these, 50% of primary disease cases and 73% of recurrent primary disease cases have achieved clinical resolution with 5% imiquimod therapy alone. These findings suggest that imiquimod provides a viable alternative to surgical excision for vulval EMPD. However, we acknowledge that this is a simple retrospective analysis and that treatment scheduling and follow-up needs investigation in a trial setting.
authors.affiliation: Sheffield Gynaecological Cancer Centre, Royal Hallamshire Hospital, Sheffield , UK. p.sanderson@doctors.org.uk
authors.forename: P
authors.initials: P
authors.lastname: Sanderson
authors.forename: A
authors.initials: A
authors.lastname: Innamaa
authors.forename: J
authors.initials: J
authors.lastname: Palmer
authors.forename: J
authors.initials: J
authors.lastname: Tidy
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D000634:Aminoquinolines / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002990:Clobetasol / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D000077271:Imiquimod; D008875:Middle Aged; D010145:Paget Disease, Extramammary / Q000188:drug therapy*; D014846:Vulvar Neoplasms / Q000188:drug therapy*
chemical_list: D000634:Aminoquinolines; D000893:Anti-Inflammatory Agents; D000970:Antineoplastic Agents; C010893:clobetasone butyrate; D002990:Clobetasol; D000077271:Imiquimod